Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
Nation Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
CNS Neurosci Ther. 2024 Aug;30(8):e14912. doi: 10.1111/cns.14912.
To investigate the association between coronary heart disease (CHD) and the risk of perioperative ischemic stroke in patients undergoing noncardiac surgery.
This retrospective study evaluated the incidence of ischemic stroke within 30 days after a noncardiac surgery. A cohort of 221,541 patients who underwent noncardiac surgery between January 2008 and August 2019 was segregated according to whether they were diagnosed with CHD. Primary, sensitivity, and subgroup logistic regression analyses were conducted to confirm that CHD is an independent risk factor for perioperative ischemic stroke. Propensity score matching analysis was used to account for the potential residual confounding effect of covariates.
Among the 221,541 included patients undergoing noncardiac surgery, 484 patients (0.22%) experienced perioperative ischemic stroke. The risk of perioperative ischemic stroke was higher in patients with CHD (0.7%) compared to patients without CHD (0.2%), and multivariate logistic regression analysis showed that CHD was associated with a significantly increased risk of perioperative ischemic stroke (odds ratio (OR), 3.7943; 95% confidence interval (CI) 2.865-4.934; p < 0.001). In a subset of patients selected by propensity score matching (PSM) in which all covariates between the two groups were well balanced, the association between CHD and increased risk of perioperative ischemic stroke remained significantly significant (OR 1.8150; 95% CI, 1.254-2.619; p = 0.001). In the subgroup analysis stratified by age, preoperative β-blockers, and fibrinogen-to-albumin ratio (FAR), the association between CHD and perioperative ischemic stroke was stable (p for interaction >0.05). Subgroup analyses also showed that CHD was significantly increased the risk of perioperative ischemic stroke in the preoperative mean arterial pressure (MAP) ≥94.2 mmHg subgroups (p for interaction <0.001).
CHD is significantly associated with an increased risk of perioperative ischemic stroke and is an independent risk factor for perioperative ischemic stroke after noncardiac surgery. Strict control of preoperative blood pressure may reduce the risk of perioperative ischemic stroke for patients with CHD undergoing noncardiac surgery.
探讨非心脏手术后冠心病（CHD）与围术期缺血性卒中风险的关系。
本回顾性研究评估了 2008 年 1 月至 2019 年 8 月间 221541 例接受非心脏手术患者 30 天内缺血性卒中的发生率。根据是否诊断为 CHD，将患者分为 CHD 组和非 CHD 组。采用主要、敏感性和亚组逻辑回归分析，确认 CHD 是围术期缺血性卒中的独立危险因素。采用倾向评分匹配分析来解释协变量的潜在残余混杂效应。
在纳入的 221541 例接受非心脏手术的患者中，484 例（0.22%）发生围术期缺血性卒中。CHD 患者（0.7%）的围术期缺血性卒中风险高于无 CHD 患者（0.2%），多变量逻辑回归分析显示 CHD 与围术期缺血性卒中风险显著增加相关（比值比[OR]，3.7943；95%置信区间[CI]，2.865-4.934；p<0.001）。在根据倾向评分匹配（PSM）选择的亚组患者中，两组之间的所有协变量均得到很好的平衡，CHD 与围术期缺血性卒中风险增加之间的关联仍然显著（OR 1.8150；95%CI，1.254-2.619；p=0.001）。按年龄、术前β受体阻滞剂和纤维蛋白原与白蛋白比值（FAR）分层的亚组分析中，CHD 与围术期缺血性卒中的关联是稳定的（p 交互作用>0.05）。亚组分析还表明，在术前平均动脉压（MAP）≥94.2mmHg 的亚组中，CHD 显著增加了围术期缺血性卒中的风险（p 交互作用<0.001）。
CHD 与围术期缺血性卒中风险显著相关，是非心脏手术后围术期缺血性卒中的独立危险因素。对于接受非心脏手术的 CHD 患者，严格控制术前血压可能会降低围术期缺血性卒中的风险。
